Provider Demographics
NPI:1326013566
Name:FRYER, GREGORY MARCEL (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:MARCEL
Last Name:FRYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:190 HATCHER LN
Mailing Address - Street 2:STE B
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-5988
Mailing Address - Country:US
Mailing Address - Phone:931-221-0902
Mailing Address - Fax:931-221-0602
Practice Address - Street 1:190 HATCHER LN
Practice Address - Street 2:STE B
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-5988
Practice Address - Country:US
Practice Address - Phone:931-221-0902
Practice Address - Fax:931-221-0602
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000034903207Q00000X
GA041120207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ003185Medicaid
TNQ003185Medicaid